Kent Harrison Robbins - Ana Gazarian eSlf
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City of Miami Beach Office of the City Clerk "c'
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat or
modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the City
Manager or any city board or.committee; or any action, decision or recommendation of any city personnel during the time period of the
entire decision-making process on such action, decision or recommendation that foreseeably will be heard or reviewed by the city
commission, or a city board or committee. The term specifically includes the principal as well as any employee engaged in lobbying
activities. The term"Lobbyists"has specific exclusions. Please refer to Ordinance 2004-3435.
Robbins Kent Harrison
NAME OF LOBBYIST: (Last) (First) (M.I)
19 W. Flagler St. Suite 402 Miami Florida 33130
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)532-0500 (305)531-0150 khr @khrlawoffices.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Ana Gazarian
NAME OF PRINCIPAL/CLIENT:
6 Farrey Lane Miami Beach Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786) 533-2829 ana.gazariannems-ircor
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] ==
pi
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: N/f}
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Nlti- w ='T;
n.SPECIFIC LOBBY
P ISSUE:, --• ti
Legal Representation of Ana Gazarian concerning impacts related to DRB File No.23155,Rene Gonzalez's Application for Design-Review:Board Approval
for the construction of a new three-story sinale-familv residence and related variances and waivers at 7 Farrev Ln.,Miami Beach,FL 33139
Issue to be lobbied(Describe in detail):
iii
CITY AGENCIES/INDIV.IDUALS"TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel sought to be lobbied,and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's
commencement of service with the city to the present date,stating the general nature of the subject contractual relationship.
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
Planning Board None X
Design Review Board None X
Land use board Nune X
City Commission None X
Planning Ctaff None X
Mayor None X
City Manager's Office None X
City Attorney's Office None X
Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,familial or professional
relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2-482(g)Any Financial,Familial or Professional Relationship
NONE
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W. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATiON(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
AA) LOBBYIST DISCLOSURE:(Required) $595.00 /
per brittl-
e) PRINCIPALS NCIPA.L3 DISCLOSURE(OF LOBBYIST COMPENSATION": $595.00 /
(REQUIRED), e ppr hniir
The following inforrnaiion must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled'Prohibited Campaign Contributions By Lobbyists On Procurement
Dues':
_Yes_Alo: Are you lobbying on a present or pending bid for goods.equipment or services,or on a present or pending
award for goods.equipment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled Prohibited Campaign Contributions By Lobbyists On Real Estate
Deveiopment Issues':
_Yes 4Jo: Are you lobbying on a pending application for a Development Agreement:with the City or application for
change of zoning map designation or change to the City`s Future Land Use Map?
3) Pursuant to Miami Beach City Code Section 2-482(h)Any person(except those exempt from the definition of'lobbyist'as set .
forth in Section 2-481 above)who only appears as a representative of a not-for-profit corporation or entity without special
compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any
item,shall register with the clerk as required by this section but shall not be required to pay any registration fees.
_Yesjtlo: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement.
V_ SIGNATURE UNDER OATH:
e
ON FEBRUARY 28 OF EACH YEAR.EACH LOBBYIST SHALL SU•MIT TO T , CITY CL • , SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES. AS WELL • . 0 j'EN SATION 'ECEIV IN ' E CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT "L' AL iiE FILED , '4 IF TH E ,VE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD I / i
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ip ure of Lob. ..
I do solemnly swear that all of e f -acing fa, s al., true and co .t a I have read or am familiar with the provisions contained
in Section 2-482 of the Mani Bel,) City Cod.. •,4H reporting re, -niy
Signature of Lobbyist: .-� ,
Signature of PrincipatrClient: ( �►_s_f ,rg.-<<<-
VI. LOBBYIST IDENT1FICA * •. PRINCIPAL IDENTIFICATION: I.
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Produced ID ; ;g44 ✓Prod Produced ID P e cp art rry eCtden4 Ca i CI
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Form of identification .' '',;•* - Fomi of Identification
ers ona y known(Lobbyist) §,-m- Personally known(Principal)
STAMP 2 K°' Kingdom of Spain )
VII. SIGNATURE AND TAMP OF NOTARY: F 92-a - Province and City of Las Palmas,de Gran Canaria )SS
;�o m ` Consular Agency of the United States of America )6 State of Florida, County of Miami-Dade L P, z., ;
S'h'orn o 3�'►ri subscribe before nee °=f 6,• y� „ 'yr ,
This day of AL. ,20ic ._ „, tan r.. t ti arr. .of a o Ana Marian',yftlar�JFigufer�ia �'h„
aOD Consu rA erit. he U iced Stomates�of�America
Sigria o+ is N• arj 17. ate of Florida Caney lams;;' i', ,Q00077 .1;:1.+ .fir ,
Notary o f Lobbyist's signature NoYal7zatlon,of I�rrnofp}�l srttra
u ti r,
TO BE COMPLETED BY CITY CL, 'S TA.FF ONLY r ; i):110,::. ,'
Annual Registration fee: t Plea I No Amount Paid S 3 50 ('A ; ,.`' r '''„��1� .Z9ste Paid L -- I N
Lobbyist Registration Form receiv and verified by:
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City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Cler k CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
Kent Harrison
LOBBYIST NAME: Robbins
I understand that no later than February 28 of each year, I must file the following form,
pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's Office for
all active lobbying issues.
1) LOBBYIST EXPENDITURE AND COMPENSATION FORM
Failure to file these forms on a timely basis will result in my name being transmitted to
the Miami-Dade County Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, or I am no
longer lobbying on that issue or for that principal, I am required to immediately notify
the City Clerk's Office of lobbyist withdrawal in writing.
Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist(or principal)who
fails to timely file a Statement and in addition to any other penalties which may be
imposed as provided in Section 2-485.1, a fine of$50.00 a day shall be assessed for all
Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal)
to file the Statement or pay the assessed fines after notification.
Any lobb ,ist, who fails to file the required Statement by April 30th, 2012, shall be
automa . ally suspended • •m lobbying until all fines are paid, unless the fine has been
app- I d to e Miami-i d= ounty Commission on Ethics and Public Trust.
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Si■nature: Date:
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